Efficacy of low-dose radiotherapy in painful gonarthritis: experiences from a retrospective East German bicenter study

Stephanie Keller, Klaus Müller, Rolf-Dieter Kortmann, Ulrich Wolf, Guido Hildebrandt, André Liebmann, Oliver Micke, Gert Flemming, Dieter Baaske, Stephanie Keller, Klaus Müller, Rolf-Dieter Kortmann, Ulrich Wolf, Guido Hildebrandt, André Liebmann, Oliver Micke, Gert Flemming, Dieter Baaske

Abstract

Purpose: To evaluate the efficacy of low-dose radiotherapy in painful gonarthritis.

Methods: We assessed the medical records of 1037 patients with painful gonarthritis who had undergone low-dose radiotherapy between 1981 and 2008. The subjective patient perception of the response to irradiation as graded immediately or up to two months after the completion of a radiotherapy series was evaluated and correlated with age, gender, radiological grading and the duration of symptoms before radiotherapy. Moreover, we performed a mail survey to obtain additional long-term follow-up information and received one hundred and six evaluable questionnaires.

Results: We assessed 1659 series of radiotherapy in 1037 patients. In 79.3% of the cases the patients experienced a slight, marked or complete pain relief immediately or up to two months after the completion of radiotherapy. Gender, age and the duration of pain before radiotherapy did not have a significant influence on the response to irradiation. In contrast, severe signs of osteoarthritis were associated with more effective pain relief. In more than 50% of the patients who reported a positive response to irradiation a sustained period of symptomatic improvement was observed.

Conclusions: Our results confirm that low-dose radiotherapy is an effective treatment for painful osteoarthritis of the knee. In contrast to an earlier retrospective study, severe signs of osteoarthritis constituted a positive prognostic factor for the response to irradiation. A randomized trial is urgently required to compare radiotherapy with other treatment modalities.

Figures

Figure 1
Figure 1
Overall response to radiotherapy. Pain, as it was subjectively graded by the patients immediately or up to two months after the completion of a series of radiotherapy.
Figure 2
Figure 2
Response to radiotherapy split by gender. Pain, as it was subjectively graded by the patients immediately or up to two months after the completion of a series of radiotherapy. There was no significant difference in radiation-induced pain relief between men and women (p = 0.347).
Figure 3
Figure 3
Response to radiotherapy split by age. Pain, as it was subjectively graded by the patients immediately or up to two months after the completion of a series of radiotherapy. There was no significant difference in radiation-induced pain relief between under- and over-sixty-year-old patients (p = 0.505).
Figure 4
Figure 4
Response to radiotherapy split by radiological severity of gonarthritis. Pain, as it was subjectively graded by the patients immediately or up to two months after the completion of a series of radiotherapy. There was a significant difference in radiation-induced pain relief between minimal/ moderate and severe gonarthritis (p = 0.036).
Figure 5
Figure 5
Response to radiotherapy split by duration of pain prior to treatment. Pain, as it was subjectively graded by the patients immediately or up to two months after completion of a series. There was no significant difference in radiation-induced pain relief between the patients who reported a history of pain of less than a year, 1 to 3 years or more than 3 years prior to radiotherapy (p = 0.699).
Figure 6
Figure 6
Response to radiotherapy according to the additional mail survey (106 evaluable questionnaires). Pain after the end of radiotherapy, as it was subjectively graded by the patients in a retrospective mail survey, which was effected in 2010, i.e., two to fourteen years after treatment.
Figure 7
Figure 7
Response to radiotherapy according to the additional mail survey (106 evaluable questionnaires). Mobility after the end of radiotherapy, as it was subjectively graded by the patients in a retrospective mail survey, which was effected in 2010, i.e., two to fourteen years after treatment.
Figure 8
Figure 8
Response to radiotherapy according to the additional mail survey. Duration of clinical improvement after radiotherapy, as it was subjectively reported by the patients in a retrospective mail survey, which was effected in 2010.

References

    1. Felson DT. Osteoarthritis. Rheum Dis Clin North Am. 1990;16:499–512.
    1. Engelhardt M. Epidemiologie der arthrose in westeuropa. Dtsch Z Sportmed. 2003;54:171–175.
    1. Fried G. Die röntgentherapie der arthritis. Strahlentherapie. 1934;49:634–675.
    1. Toschke G. Zur röntgenbehandlung von gelenkerkrankungen. Strahlentherapie. 1941;70:443–456.
    1. Mücke R, Seegenschmiedt MH, Heyd R, Schafer U, Prott FJ, Glatzel M, Micke O. Radiotherapy in painful gonarthrosis. Results of a national patterns-of-care study. Strahlenther Onkol. 2010;186:7–17. doi: 10.1007/s00066-009-1995-7.
    1. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing committee for international clinical studies including therapeutic trials (ESCISIT) Ann Rheum Dis. 2003;62:1145–1155. doi: 10.1136/ard.2003.011742.
    1. Kellgren JH, Lawrence JS. Osteo-arthrosis and disk degeneration in an urban population. Ann Rheum Dis. 1958;17:388–397. doi: 10.1136/ard.17.4.388.
    1. Von Pannewitz G, editor. Roentgen therapy for deforming arthritis. Leipzig: Thieme; 1933.
    1. Fischer U, Kamprad F, Koch F, Ludewig E, Melzer R, Hildebrandt G. The effects of low-dose Co-60 irradiation on the course of aseptic arthritis in a rabbit knee joint. Strahlenther Onkol. 1998;174:633–639. doi: 10.1007/BF03038512.
    1. Keinert KSU, Schumann E. Ergebnisse der strahlentherapie der arthrosis deformans des kniegelenks. Dt Gesundh-Wesen. 1982;10:445–447.
    1. Keilholz L, Seegenschmiedt H, Sauer R. Radiotherapy for painful degenerative joint disorders. Indications, technique and clinical results. Strahlenther Onkol. 1998;174:243–250. doi: 10.1007/BF03038716.
    1. Ruppert R, Seegenschmiedt MH, Sauer R. Radiotherapy of osteoarthritis. Indication, technique and clinical results. Orthopade. 2004;33:56–62. doi: 10.1007/s00132-003-0568-1.
    1. Sautter-Bihl ML, Liebermeister E, Scheurig H, Heinze HG. Analgetic irradiation of degenerative-inflammatory skeletal diseases. Benefits and risks. Dtsch Med Wochenschr. 1993;118:493–498. doi: 10.1055/s-2008-1059354.
    1. Glatzel MF D, Bäsecke S, Krauß A. Prognostic factors of success of analgesic radiotherapy for gonarthrosis. Strahlenther Onkol. 2004;180(Sondernr 1):6.
    1. Niewald M, Seegenschmiedt MH, Micke O, Graeber S, Muecke R, Schaefer V, Scheid C, Fleckenstein J, Licht N, Ruebe C. Randomized, multicenter trial on the effect of radiation therapy on plantar fasciitis (painful heel spur) comparing a standard dose with a very low dose: mature results after 12 months‘ follow-up. Int J Radiat Oncol Biol Phys. 2012;84:e455–462. doi: 10.1016/j.ijrobp.2012.06.022.
    1. Heyd R, Tselis N, Ackermann H, Roddiger SJ, Zamboglou N. Radiation therapy for painful heel spurs: results of a prospective randomized study. Strahlenther Onkol. 2007;183:3–9.
    1. Ott OJ, Hertel S, Gaipl US, Frey B, Schmidt M, Fietkau R. Benign painful elbow syndrome: first results of a single center prospective randomized radiotherapy dose optimization trial. Strahlenther Onkol. 2012;188:873–877. doi: 10.1007/s00066-012-0179-z.
    1. Liebmann A, Hindemith M, Jahns J, Madaj-Sterba P, Weisheit S, Kamprad F, Hildebrandt G. Low-dose X-irradiation of adjuvant-induced arthritis in rats. Efficacy of different fractionation schedules. Strahlenther Onkol. 2004;180:165–172. doi: 10.1007/s00066-004-1197-2.
    1. Trott KR, Parker R, Seed MP. The effect of x-rays on experimental arthritis in the rat. Strahlenther Onkol. 1995;171:534–538.
    1. Hildebrandt G, Jahns J, Hindemith M, Spranger S, Sack U, Kinne RW, Madaj-Sterba P, Wolf U, Kamprad F. Effects of low dose radiation therapy on adjuvant induced arthritis in rats. Int J Radiat Biol. 2000;76:1143–1153. doi: 10.1080/09553000050111613.
    1. Jansen JT, Broerse JJ, Zoetelief J, Klein C, Seegenschmiedt HM. Estimation of the carcinogenic risk of radiotherapy of benign diseases from shoulder to heel. Radiother Oncol. 2005;76:270–277. doi: 10.1016/j.radonc.2005.06.034.
    1. Von Pannewitz G. Röntgentherapie der arthrosis deformans. Strahlentherapie. 1953;92:375–382.

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